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By Heather Campbell

Diogenes syndrome is a behavioural disorder characterized by extreme self-neglect, domestic squalor, hoarding, social withdrawal, refusal of help, and a lack of concern about one’s living condition 1. It is mostly found in older adults, but it can occur across all ages and socioeconomic backgrounds. Affected individuals are usually of average or above-average intelligence, and they sometimes have other mental illnesses, such as schizophrenia or frontotemporal dementia.2

The term “Diogenes syndrome” was first used by English geriatricians in 1975.3  Diogenes was a Greek philosopher who gave up all his personal possessions. Thus some scholars argue that the name Diogenes is inaccurate because the philosopher chose his lifestyle, and there is not enough evidence that people with the diagnosis make a voluntary choice.4 

Other terms used to describe the condition include senile squalor syndrome, social breakdown disorder, gross self-neglect syndrome, and litter hoarding syndrome.

Identifying people with Diogenes syndrome can be difficult. It is often by chance, such as when an emergency occurs (e.g., a fall or a fire) or when a family member or neighbour notices odours coming from the person’s house.5

Case law – civil matters
Outside of Quebec, only a handful of reported legal cases in Canada mention Diogenes syndrome. Matters tend to involve eviction, involuntary commitment, and capacity assessments. Here are three examples.  

  • Residential tenancies (eviction)

In Hamilton, the Ontario Landlord and Tenant Board terminated the tenancy of a 90-year-old woman with suspected Diogenes syndrome 6. She brought food and garbage from outside and hoarded it in her unit. Her place was described as dirty, and it had attracted bugs. The Board said the living conditions posed a fire, safety and health risk to the tenant and others in the complex.

The Board ordered termination, noting that the tenant’s daughter was in the process of negotiating alternative accommodation for her.

  • Involuntary commitment to psychiatric hospital

In Thunder Bay, the Ontario Consent and Capacity Board rescinded the certificate of involuntary admission for a 74-year-old woman who had lived alone for many years.7

She was brought to the hospital by police, who had been called to help remove 37 cats from her home. Many were so ill that they had to be euthanized.

 A doctor at the hospital said the patient had Diogenes syndrome, delusional disorder, mild cognitive impairment and paranoid personality disorder        

Her house was described as filthy with cat feces and urine. She did not have running water or a working toilet. She failed to get dental care. She was hard of hearing but had no hearing aid. She used a magnifying glass instead of prescription glasses. She was, however, physically quite fit.

In social services notes, she was quoted as saying, “as you know, I am a very stubborn person and have my own way of doing things.”

The Board observed that the patient “had an unusual personality.” She was described as “a loner who reacted dramatically to conflict with others as when she threatened to eat newspaper if she could not take her purse to the dining room.”

The Board concluded, however, that there was “no clear, cogent and compelling evidence” that she had a mental disorder. There was no evidence, for example, as to why she hoarded cats or how her housekeeping had progressed over the years.

As a result, the Board found that the criteria for involuntary status were not met.

  • Capacity to manage property

In Kingston, an 86-year-old woman who had lived alone for several years was found incapable of managing her property.8 She had been admitted to hospital after she was found at home lying on the floor. Her home was filled with garbage, feces and decaying animals. She was diagnosed with mild cognitive impairment and Diogenes syndrome.

At the hearing, she was able to demonstrate a basic understanding of her monthly finances, and an understanding of the necessity to live within her means. Her lawyer described her as frugal; the capacity assessor said her refusal to spend money on things such as dental care was evidence of Diogenes syndrome.

While she had a reasonable understanding of her monthly finances, the Consent and Capacity Board found that she lacked understanding of her real property (i.e., her house). She said she inherited it from her sister, but there did not appear to have been any estate legal work completed. The Board also found that she “did not show any appreciation for the completely uninhabitable state of the house.”

In the end, the Board concluded that the evidence of mild dementia, slight memory loss, Diogenes syndrome, and brain damage from small strokes indicated that she lacked capacity to manage her property.   

This post is part 1 of 2. Next, I will look at Diogenes syndrome by proxy and the criminal law (January 4, 2017)



References:

1 Giovanni Zuliani et al, “Diogenes syndrome or isolated syllogomania? Four heterogenous clinical cases” (2013) 25 Aging Clin Exp Res 473 at 473; Jeffrey DC Irvine & Kingsley Nwachukwu, “Recognizing Diogenes syndrome: a case report” (2014) 7 BMC Research Notes 276 at 276.

2 Irvine & Nwachukwu, ibid.

3 ANG Clark, GD Mankikar & Ian Gray, “Diogenes syndrome: A clinical study of gross neglect in old age” (1975) 1 The Lancet 366.

4 Zuliani et al, supra note 1 at 473-74; Shabbir Amanullah, Sabu K Oomman & Soumitra Shankar Datta, “‘Diogenes Syndrome’ Revisited” (2009) 12 German J Psychiatry 38 at 38.

5 Brian Christopher Misiaszek, “Diogenes Syndrome: A Geriatric syndrome of gross self neglect”, online: <https://fhs.mcmaster.ca/medicine/geriatric/docs/Diogenes-Syndrome-Rounds.pdf>.

6 See e.g. SOL-09065-10 (Re), 2010 CanLII 65548 (ON LTB).

7 See e.g. A.D. (Re), 2008 CanLII 28423 (ON CCB).

8 See e.g. H (Re), 2010 CanLII 47509 (ON CCB).


About the author:


HeatherCampbellHeather Campbell is a PhD Student (Law) at Queen’s University.
You can follow her on Twitter @SeniorsLaw.

 

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